Action Points

Patients with cancer developed a greater risk of arterial thromboembolism soon after diagnosis, especially those with certain types of cancer.

Note that at greatest risk were patients with lung cancer, but breast, colorectal, bladder, non-Hodgkin's lymphoma (NHL), and gastric cancers were still tied to MI at 2 years.

Patients with cancer developed a greater risk of arterial thromboembolism soon after diagnosis, especially those with certain types of cancer, researchers found.

Six months after a cancer diagnosis, patients had double the rate of arterial thromboembolism compared with peers without cancer (4.7% versus 2.2%, HR 2.2, 95% CI 2.1-2.3), according to Babak B. Navi, MD, MS, of New York's Weill Cornell Medicine, and colleagues in the Journal of the American College of Cardiology.

Thromboembolic risk climbed according to cancer stage severity but generally dropped over time since diagnosis. At greatest risk were patients with lung cancer, but breast, colorectal, bladder, non-Hodgkin's lymphoma (NHL), and gastric cancers were still tied to MI at 2 years.

"Our findings raise the question of whether patients with newly diagnosed malignant cancer, particularly those with advanced disease, should be considered for antithrombotic and statin medicines for primary prevention of cardiovascular disease," the authors said.

"Given that patients with cancer are also prone to bleeding due to frequent coagulopathy and invasive procedures, carefully designed clinical trials are needed to answer these questions," they continued, citing two such ongoing trials on apixaban (Eliquis) and aspirin/simvastatin (Zocor) as primary prevention in high-risk cancer patients.

"In the meantime, physicians treating patients with cancer should manage general cardiovascular risk factors such as hypertension, and they should be vigilant for symptoms or signs of heart disease or stroke."

This should be the main takeaway of this study, suggested Edward T.H. Yeh, MD, and Hui-Ming Chang, MD, MPH, both of University of Missouri, Columbia. In an accompanying editorial, they called Navi's study "a call to action for cardiologists to work closely with oncologists to prevent the occurrence of MI or ischemic stroke in cancer patients; and, for interventional cardiologists to take an active role in managing cancer patients with acute MI."

Whether cancer itself or therapy for it is the main trigger of cardiovascular events remains unknown, Yeh and Chang commented. Another potential culprit: the psychological impact of cancer diagnosis.

"After cancer diagnoses, cancer patients can develop a post-traumatic stress response. It is well known that stress increases the risk of MI. Perhaps after successful treatment or learning how to cope with the cancer diagnosis, the stress level would returns to normal after 1 year," the duo suggested.

For their study, Navi's group linked the Surveillance Epidemiology and End Results database to Medicare claims. Study participants were ages 66 or older, and were diagnosed with breast, lung, prostate, colorectal, bladder, pancreatic, or gastric cancer, or NHL, from 2002 to 2011. One-fifth had stage 4 disease at diagnosis.

Matched to Medicare enrollees as controls, cancer patients were part of 279,719 pairs (median age 74, 48% men). The median follow-up was 2.8 years for cancer patients versus 5.0 years for controls.

Poor prognosis was confirmed among patients with arterial blood clots, who had tripled odds of mortality on follow-up using careful matched analysis against controls (HR 3.1, 95% CI 3.0-3.1).

The linked dataset used in the present study lacked electrocardiography and imaging information, and represented just 64% of all malignant cancer in the U.S, the investigators noted. The analysis also couldn't account for increased surveillance of cancer patients as a reason for higher event detection.

Nevertheless, if patients develop thrombocytopenia after chemotherapy, they should still get treated for acute coronary syndrome, Yeh and Chang urged.

"Revascularization can still proceed successfully with meticulous attention to hemostasis," they stated.

The study was funded by NIH grants and the Florence Gould Endowment for Discovery in Stroke.

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